[Non-transecting anastomotic urethroplasty for strictures of the bulbar urethra. Systematic review].

The results of using non-transecting anastomotic urethroplasty in men with bulbous urethral strictures are presented in the review. A total of 25 original publications were found, including 20 foreign and 5 Russian articles. The studies included from 1 to 358 patients who underwent anastomotic urethroplasty without transection of the corpus spongiosum (average number of patients in a study was 54). Etiological factors were indicated in 17 articles. Most studies (10 out of 17) indicated idiopathic etiology as the predominant one. There was no correlation between the results of the procedure and the etiology of urethral stricture. The mean length of urethral stricture in the vast majority of studies was less than 2 cm, and only in a few studies it was larger, with a maximum mean value of 3.9 cm. Postoperative complication rates were reported in 20 studies and ranged from 0% to 23.9% within one study (median 8.4%). In general, mild complications occurred, corresponding to category I-II according to the Clavien-Dindo classification. The incidence of erectile dysfunction was evaluated in 18 studies and ranged from 0% to 23% (average value of 6.5%). The success of non-transecting anastomotic urethroplasty averaged 94.7% (82-100%) with a median postoperative follow-up of 24.5 months (3-150 months). In 9 out of 25 studies, an additional comparison with transecting technique was done. In 6 studies, the superiority of the non-transecting technique in terms of treatment success and preservation of sexual function was found. The obtained results showed the high efficiency and safety of non-transecting anastomotic urethroplasty in case of short strictures of the bulbous urethra.

[Giant prostate stones: case report].

Small prostate stones are often found incidentally during clinical and radiological examination. Large stones, however, also may develop, replacing completely the prostate tissue and causing various symptoms. Such a large stones are commonly formed due to chronic urine reflux. There are 20 publications in the literature devoted to the patients with giant prostate stones. Open as well as endoscopic procedures can be performed. In our clinical case both approaches were done simultaneously. Such tactic was chosen in order to carry out a single-stage intervention, immediately solving two problems, i.e., urethral stricture and a giant prostate stone.

[Perineal urethrostomy: results, clinical, statistical and terminological aspects].

The analysis of the results of perineal urethrostomy for urethral stricture in men for the period from 2000 to 2020 is presented in the article. We identified 29 original articles devoted to this technique, including 4 Russian and 25 foreign publications. In two studies, there were more than 100 patients, four studies included from 51 to 77 men, and in remaining studies less than 50 patients were analyzed. Complete data on all pre- and postoperative aspects of perineal urethrostomy were provided only in a few studies. In the overwhelm of cases, perineal urethrostomy was performed after one or several unsuccessful reconstructive procedures and only in few patients it was done prior to various types of urethroplasty. It was not possible to establish any association between etiological factors and localization of urethral stricture among these patients. The incidence of pan-urethral stricture ranged from 28.6% to 100%. Only in one study the average stricture length was 2 cm, while in all other studies it was 5 cm or more. Postoperative follow-up was on average 14 to 62 months. Treatment success with perineal urethrostomy ranged from 0% to 100%, but in most studies it was 75% or more. The most common perineal urethrostomy technique used included Blandy technique, and Johanson and 7-flap techniques.

[Non-transecting anastomotic urethroplasty].

The review analyzes the results of using non-transecting anastomotic urethroplasty in men with urethral strictures. Identified 14 original studies using this technique: 13 foreign and 1 Russian. In total, this technique was applied in 704 patients. This technique was used in 85% of cases with bulbar urethral stricture, in 15% - with posterior stricture.The average length of the urethral stricture in all studies was less than 2 cm, except for two works, where the average stricture length was 2.3 cm and 3.9 cm, respectively. This technique is equally successfully applied in all etiological variants of urethral stricture. The incidence of postoperative complications in all studies using non-transecting anastomotic urethroplastyaveraged 13.7%.Postoperative complications were mostly mild and corresponded to G1 according to Clavien-Dindo classification.According to 10 out of 14 studies that evaluated the effect of surgical treatment on the occurrence of erectile dysfunction (ED), the incidence of ED de novo was on average 13.4%. The success of treatment with the use of non-transecting anastomotic urethroplastyaveraged 95% (82-100%) with a median postoperative follow-up of 27 months (6-64 months). In 4 out of 14 studies, an additional comparison was transecting versus non-transecting techniques. Non-transecting technique was not inferior to transecting technique by any criterion, but, on the contrary, exceeded it in a number of indicators, including the dynamics of sexual function after surgery.On the basis of available studies on the use of non-transecting anastomotic urethroplasty, this technique should be recognized as a highly efficient and reasonably safe method for treating short urethral strictures and recommended for widespread clinical use.

[Transrectal ozone and magnetic therapy for treatment of chronic bacterial prostatitis].

AIM: To evaluate the efficiency of combined transrectal ozone and magnetic therapy for the treatment of chronic bacterial prostatitis (CBP). MATERIALS AND METHODS: A total of 142 men with CBP were included in the study and allocated to different treatment, including standard therapy for 6 weeks (n=40), transrectal magnetic therapy in addition to standard therapy (n=35), transrectal ozone therapy in addition to standard therapy (n=37), transrectal magnetic and ozone therapy in addition to standard therapy (n=30). Treatment results were evaluated 3 months after the completion of therapy. RESULTS: The most pronounced positive improvement in all evaluated parameters was observed among patients who received both magnetic and ozone therapy, according to the criteria of all domains of the NIH-CPSI questionnaire, IIEF-5 questionnaire, and based on the changes in prostate volume, maximum urination rate, residual urine volume and microscopic examination of prostate secretion. CONCLUSION: To achieve optimal results in the treatment of CBP, it is necessary to use both consequently magnetic and ozone therapy, in addition to standard therapy.

[Use of buccal graft for the management of ureteral strictures].

This review analyses of the results of using buccal mucosa graft for the management of ureteral strictures. The authors identified sixteen original studies presenting the results of ureteral reconstruction using buccal grafts. Of them, twelve, three and one studies used the open, robotic and laparoscopic technique, respectively. Open surgery was performed 44 times in 42 patients (2 patients underwent bilateral ureteroplasty) with an average ureteral stricture length of 6.0 (2.5-11) cm. Ureteral patency was restored in 93.2% (41/44) of patients with an average follow-up of 26 (3-85) months. The robotic technique was used in 18 patients with an average ureteral stricture length of 3.25 (1.5-6) cm. Positive results after similar operations were achieved in 88.9% (16/18) of patients with an average follow-up of 15 (4-30) months. The laparoscopic technique was used only once for a ureteral stricture measuring 3 cm in length and was characterized as successful at a follow-up of 9 months. All surgical modalities were associated with minimal risk of early and late postoperative complications. The review results suggest that buccal substitution ureteroplasty can be regarded as an advantageous alternative to more complicated surgical procedures associated with greater complication rates (ileal ureteral substitution and kidney autotransplantation) used for long ureteral strictures.

[Analysis of clinical effectiveness and risk factors for complication of percutaneous nephrolototripsia in patients with a solitary kidney].

RELEVANCE: Management of patients with large and staghorn stones of a solitary kidney is widely debated among urologists and has not been sufficiently investigated, which determined the relevance of this study. MATERIALS AND METHODS: The study comprised 80 patients with large (>20 mm) and staghorn stones of an anatomically or functionally solitary kidney. Of them, 58 patients underwent percutaneous nephrolithotripsy (PNL), and 22 had open surgery. The criterion of the treatment effectiveness was the complete stone clearance or small residual fragments sized less than 3 mm. The safety criterion was the absence of intra- and postoperative complications, according to Clavien-Dindo grading system. The study analyzed the following factors influencing the effectiveness and safety of PNL: the number of accesses; nephroscope diameter; use of a nephroscope sheath; type of lithotripter; size, density, type and composition of the stone. RESULTS: Percutaneous nephrolithotripsy demonstrated statistically significantly better safety results compared with open surgery with comparable effectiveness. Long-term stone recurrence rate after PNL and open surgery was 10.4 and 18.2%, respectively. PNL resulted in a statistically significant improvement in the kidney function while it worsened after open surgery. The effectiveness of PNL depends on the stone type and size and the kind of lithotripter. It was 7.5 times greater for a large stone than for staghorn calculi and 4.6 times higher for stones sized less or equal 45 mm than for those sized > 45 mm. Ultrasonic lithotripter was 2.2 times more effective than another type of lithotripter. The safety of PNL depends on the nephroscope diameter, of a sheath, the number of accesses, the type of lithotripter and the type of stone. Using a 24-Ch nephroscope was 3.6 times safer than that with a diameter greater than 24-Ch; not using a sheath was 3.2 times safer than using it; one access was 3 times safer than at multiple ones; using an ultrasound lithotripter was 2.7 times safer than with another type of lithotripter; treating a large stone was 2.1 times safer than a staghorn stone. CONCLUSION: The study findings can be used to optimize the treatment of patients with large and staghorn stones of a solitary kidney.

[The incidence of acute urinary retention as an indicator of the quality of care for patients with benign prostatic hyperplasia].

AIM: To evaluate the incidence of acute urinary retention as an indicator of the quality of care for patients with benign prostatic hyperplasia by the example of "Urology" Program implemented in the Voronezh region. MATERIALS AND METHODS: As part of the program "Urology", the incidence of AUR was used as an indicator of quality of care for patients with BPH. Urological health care for patients with BPH was provided within a three-stage model. For each of the stages standardized packages of detailed methodological materials, including regional standards were developed. RESULTS: Over the 3 years of the program (2011-2013) questionnaire survey was conducted among 762 937 men 50-75 years old with 85.3-88.1% annual coverage of respondents. Over the past three years (2009-2012) there was consistent and statistically significant (p<0.05) decrease (from 11.27 to 1.5%) in the proportion of hospitalizations for AUR reaching a "plateau" (p>0.05) in 2012-2013. There was a significant correlation of AUR with the main indicators of effectiveness of BPH treatment: the structure of morbidity (prevalence of early BPH forms - groups 1 and 2), the number of surgical interventions, the frequency of complications (including surgical), general and specific costs for diagnosis and treatment of BPH. CONCLUSIONS: Acute urinary retention may be regarded as an integral indicator of the quality of care for patients with BPH.

[Experience in the use of mineral water "Naftusya" of Zbruchansk field in the treatment of patients with uroliths].

The study has evaluated the effect of combined treatment including slightly mineralized hydrocarbonate-magnesium-calcium mineral water "Naftusya" of Zbruchansk field on the urinary system of 47 adult patients with urolithiasis and chronic pyelonephritis aged 24 to 76 years and 3 children of different age groups. 14 patients dropped out of the study group after 1-3 days after the start of treatment due to the negative reaction of the gastrointestinal tract to the reception of water; thus, study group consisted of 36 patients. At baseline, kidney or ureteral stones were diagnosed in all patients. For adult patients, water was administered at a dose 200 ml 3 times a day, for children--50-150 ml 3 times a day, 30-40 minutes before meals for 7-20 days. Examination of patients was performed using laboratory, ultrasound and radiographic methods. It was revealed that against the background of complex treatment, discharge of small stones, their fragments and urinary sand have occurred 1-3 days earlier than with standard treatment. There was no effect on calcium and inorganic phosphate metabolism. The trend to uric acid crystalluria and reducing the pH of urine was revealed. Statistically significant reduction of leukocyturia and erythrocyturia was identified. 60% of patients had a disappearance of bacteriuria or reduction of the titer of bacteria. The results led to the conclusion of advisability of use of mineral water "Naftusya" of Zbruchansk field in the complex treatment of inflammatory processes in the urinary system and for stimulation of discharge of ureteral stones with sizes enabaling to presume their independent discharge.

[Methods of increasing the effectiveness of radical prostatectomy].

In search of ways to improve the results of radical surgical treatment of patients with prostatic cancer (PC), we analysed the results of examination and treatment of 130 patients with local PC performed in 2000-2010 years. All the patients have undergone retropubic radical prostatectomy (RPE). Of them, 25.4% received neoadjuvant hormonal therapy. Follow-up median was 53 months (16-122 months). We also estimated direct and indirect costs of RPE. Erectile dysfunction after RPE was registered in 93.1% patients, urinary incontinence--in 20% patients, anastomosis stricture--in 22.6%. Five and 10 year recurrence-free survival was 80 and 72%, respectively. Total (direct and indirect) costs of one PC patient's surgical treatment (RPE) reached 140891,29 roubles. Our calculations show that certain measures taken in practical activity of the urologists can reduce direct costs by about 25%. Thus, our study demonstrates that it is possible to avoid unjustified expenses and achieve good outcomes in surgical treatment of PC.